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Extra resources for 2008 Kaplan USMLE Step 1 Home Study Program-Brand New Volume III: Organ Systems Book 1
The depolarizing impulse travels from the SA node concentrically through the atrial myocardium, eventually reaching the atrioventricular (AV) node, which lies just beneath the right atrial endocardium,anterior to the ostium of the coronary sinus. 3. In the AV node, the impulse is conducted very slowly, delaying the impulse and allowing atrial contraction to be completed before ventricular depolarization and ventricular contraction begin. a. The AV node has a rich supply of sympathetic and parasympathetic fibers.
On the ECG, the beginning of the isoelectricTP segment is recorded. 2. The mitral valve is open and most (= 80o/o) of ventricular filling occurs (Figure I-4-11). u Physiology Figure l-4-11. Rapid ventricularfilling. a. I,eft ventricular pressure falls below left atrial pressure,opening the mitral valve; in fact, mitrd valve opening definesthe beginning of ventricular filling. Left ventricular pressurecontinues to fall in parallel with left atrial pressure. b. I^eft ventricular volume increasesrapidly as the left ventricle fills.
Diastolic murmurs also can be divided into two categories: regurgitant murmurs of aortic and pulmonic regurgitation and ventricular filling murmurs. 1. In aortic regurgitation, the murmur starts in early diastole,usually immediately after Sr. This murmur is typically_blowing,decrescendo,high-pitched, and pandiastolic and is best heard at the upper right sternal border with the patient leaning forward at full expiration 2. ln mitrd stenosis, the murmur is loudest when the flow across the mitral valve is maximal: during rapid filling in early diastole and then again during atrial systolein late diastole.